HomeMy WebLinkAboutMiscellaneous - 20 PEMBROOK ROAD 4/30/2018 (3)N
® MAPFRE The Commerce Insurance Companyw
Citation Insurance Company-Im
Commerce"
Gore Road, Webster, Massachusetts 01570
INSURANCE- 508.949.15001 www.commerceinsurance.com
November 04, 2014
BUILDING COMMISSIONER or Board of Health or
INSPECTOR OF BUILDINGS Board of Selectmen
TOWN/CITY HALL Town/City Hall
NORTH ANDOVER MA 01845
RE: Our Insured: DANIEL J MURPHY / SHEILA K MURPHY
Property Address: 20 PEMBROOK RD
Policy#: M22681
Date of Loss: 11/02/2014
File#: JPRC 19-HHCKC 1
Claim has been made involving loss, damage, or destruction of the above captioned
property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable.
If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to my attention. Please reference the above captioned insured, location,
policy number, date of loss, and file number on any correspondence.
ELIZABETH BOTTIERI Telephone: (508)949-1500 Ext: 15284
Sr Claim Representative, Property Toll Free: 1-800-221-1605, Ext: 15284
On this date, I cause copies of this notice to be sent to the persons indicated above, at the
address above, by first class mail.
November 04, 2014
CIC 254 (Rev. 4/95) MAIL M39
Date ....� . ..... c`
3361... .
40RTM TOWN OF NORTH ANDOVER
Of
PERMIT FOR GAS INSTALLATION
s\ -,..o •%<y
This certifies that �....................
has permission for gas installation ....%�� �!. r G ::.............
in the buildings of ........................
at X .......... • , North Andover, Mass.
Fee . ;� ;, . � . Lic. No.. c�� . �r . .......... .... ...........
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MAP
PARCEL
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO=�—
or print) 19 d
NORTH ANDOVER, MASSACHUSETTS /j?
Building Locations ll A, ofie'le U )0 c, Permit # ✓3 f
Amount $ 20,
Owner's Name OAq OWV4
New Renovation ❑ Replacement ❑ Plans Submitted ❑
(Print or type) q/)/f / % k one: Certificate Installing Company
Name /-� / ' tQ� lil/l� C� `'
Corp.
• � �_�„ � i �/ .ii L it
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE
❑ Partner.
A
Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No❑
If you have checked yes, pleas lndi the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent
I hereby certity that all ofthe details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the MassachuseyMStaWj3as Com and Chapter 142 of the General Laws.
(OFFICE USE ONLY)
Signature of Licensed Plumber Or Ga. Fitter
❑ Plumber
❑ Gas Fitter License Nurn6er,
❑ Master
,Journeyman
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SUB-BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND. FLOOR
3,R D. FLOOR
4TH. FLOOR
5TH. FLOOR
ST H. F L O G R
H. FLOOR
STH. FLOOR
(Print or type) q/)/f / % k one: Certificate Installing Company
Name /-� / ' tQ� lil/l� C� `'
Corp.
• � �_�„ � i �/ .ii L it
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE
❑ Partner.
A
Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No❑
If you have checked yes, pleas lndi the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent
I hereby certity that all ofthe details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the MassachuseyMStaWj3as Com and Chapter 142 of the General Laws.
(OFFICE USE ONLY)
Signature of Licensed Plumber Or Ga. Fitter
❑ Plumber
❑ Gas Fitter License Nurn6er,
❑ Master
,Journeyman
No 2108
Date:,—).—
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
-�F- "2-/</ ...............................................
This certifies that .........................
has permission to perform Ac
wiring in the building of ............ ..... / .............................
at ................ North Andover, Mass.
Lic. NoE3.-, Q, -F-9 ..............................................................
ELECTRICAL INSPECTOR
WHITE: Applicant
CANARY: Building Dept. PINK: Treasurer
ThEC0 i, 0AWE LTH0F ift `��`S' Office Use only /��r. rj
l��ftl DEPARMEWOFPUBLICSAFM Permit No.
BOARD OFFMPREVENHONMGMTIOAS527CMR 120
Occupancy &Fees Checked
UVAPPLICATIONFOR PRRAffTO PEWORMELECTRICAL WORD
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 1
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) �1 �jyl yjI^0 /fes
Owner or Tenant % 41h r✓/v�,(�h
Owner's Address SGc
... _..
Is this permit in conjunction with a building permit: Yes M No ® (Check Appropriate Box)
Purpose of Building �q YuY+? /�/ Utility Authorization No.
Existing Service � Amps L 0 (/()Volts Overhead Underground No. of Meters I
New Service 220 Amps/20/ Overhead r,7�nderground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Farms, 1 C Oni O ec)1rt 7n cic"Jii,at 4 S e rvc 'Ce e44n,9-e—
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
'No. of Lighting Fixtures
-
Swimming Pool Above
Below
Generators
KVA
andg1:1round
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery
Units
2
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals -
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local F7-1 Municipal
®
Other
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
Not Hydro Massage Tubs
No. of Motors
Total HP
r
AfER-
Ir>StrarneCaaa� Rastlant�thetecaofTvlassadC�enaalLaws
Ihawa=utLiabtlilyhst a=Pd yadj&gCanpide C maWc'itssti>sti>Valegi aiat YES NO
Iha,,e%bTiWdvabdptoof'ofsam lotheOlsx YES ('� If}mtmedladWYFS,pieasertdc*thet WofwmaWbydxdargthe
J n Fsthrtat�VahiecfE7tticalWak$
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Sigrtedut demofpajtay.
FIRM NAME LicaseNa
/�,�,, C �/'
L 1 :a� L'? �� �(/ tj V� � AiTeLNa
OWNER'S NSURANCEWAIVMIamawatethatthe Ls:ateedoesul l theft t t"sub icl6ale ivalatasm4med(staaiLam
aiidtsarmysgmfiiecnttmpamita mwaimsthism*mla t.
(Please check one) Owner Agent ED
Telephone No. PERMIT FEE $ / - ���
Location —� Cj� r"—h i-,
No. 1--5 K6 U Date
13484
TONIN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$ `lames
-.Building In 4or
(/
Div. Public Works
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TCU;'n CIL-rk
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aS^CHUge
NORTH ANDOVER
OFFICE OF
THE ZONLtiG BOARD OF aPPE.-kLS
2-71 CILL ES STREET
N01RT i -i .-NDOVER, N ASSACI?i;SET7S 0!8-`
Any appeal shall be filed
_within (20) days after the
date of filing of this notice
in the office of the Town Clerk.
NAME: Daniel J. Murphy
ADDRESS: 20 Pembrook Rd.
NOTICE OF DECISION
Property at: 20 Pembrook Rd.
DATE: 6;29199
PETITION: 007-99
North Andover, MA. 01845 i HEARING: 511 ti99 & di22/99
E
J .. .
GE I'J
TOYdi� (:
NORTH
JIUL 6 I Eo FP 'S9
F;IkX (973) 6>'S-954:
4&
The Board of Appeals held a regular meeting on Tuesday evening, June 22, 1999 upon the application of Daniel
Murphy, 20 Pembrook Rd., North Andover, requesting a Variance from Section 7, P 7.1 & 7.3 Table 2, for relief of lot
area dimension & front and side setback, in order to construct a 1' floor living room, and 2"d floor master bedroom and
garage. Petitioner is requesting a Special Permit under Section 9, P 9.2.3, in order to construct said addition which
exceeds an aggregate of more than 25% of the original use, within the R4 Zoning District.
The following members were present: William J. Sullivan, Walter F. Soule, George Earley, Ellen McIntyre.
The hearing was advertised in the Lawrence Tribune on 4127/99 & 5/4/99 and all abutters were notified by regular
mail. No persons appeared in opposition to the petition.
Upon a motion made by George Earley and 2nd by Walter F. Soule, the Board voted to GRANT a Variance from
the requirements of Section 7, P 7.1 & 7.3 for relief of area lot dimension, and front setback of 5.2", and side setback
of 8', according to the plan of land by: Scott Giles, Registered Land Surveyor, #13972, dated: 3129199. The Board
voted to grant a Special Permit under Section 9, P9.2.3 in order to construct said addition which exceeds an
aggregate of more than 25% of the original use. Voting in favor: William J. Sullivan, Walter F. Soule, George
Earley, Ellen McIntyre.
Variance
The Board finds that the petitioner has satisfied the provisions of Section 10, paragraph 10.4 of the Zoning Bylaw and that the
granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw.
10.4 Variances and Appeals
The Zoning Board of Appeals shall have power upon appeal to grant variances from the terms of this Zoning Bylaw where the
Board finds that owing to circumstances relating to soil conditions, shape, or typ ohy of the land or structure and especially
affecting such land or structures but not affecting generally the zoning district in general, a literal enforcement of the provisions of
this Bylaw will involve substantial hardship, financial or otherwise, to the petitioner or applicant, and that desirable relief may be
granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose
of this Bylaw.
SPECIAL PERMIT
The Board finds that the applicant has satisfied the provision of Section 9, paragraph 9.2 of the Zoning Bylaw and that such
change, extension or alteration shall not be substantially more detrimental than the existing non -conforming structure to the
neighborhood.
By Order of the Bd rof7e,
4j 1,,.. T AA -A.-
William J. Sulli an, Chairman
l3U:'.Kll UI' :11'PL::;LS tiSi;-`)`.�li r31�IL'Jr\C1S uSS-J'1' C'U�'SF.it'::�.'i�IUN �i:;S-9530 Ill:ai_ i H c;5'-71a!i i'!_... :i`�C; - ;i.i- •� 1.'
KNl
N
FORM U - LOT RELEASE FORM
INSTRUCTIONS:. This form is used to verify that all necessary approvals/permits from
Boards and -Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
`*APPLICANT FILLS OUT THIS Sr_
APPLICANT
�._ _ _ _ IIt,L 5��.�ONE ✓i `�3�
LOCATION: Assessors Map Number PARC EI_
SUBDIVISION c-� LOT (S)
STREET �� �A— G \�-2� = ST. NUMBER
USE ONLY��
R OMMENDATIONS OF TOWN AGENTS:
I 1.1.h aW
ERVATION ADMINISTRATOR
XX COMMENTS
TOWN PLANNER
COMMENTS
FOOD INSPECTOR -;-HEALTH
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED 1 /
9
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEVVER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED EY BUILDING iNSPECTOR DATE.
Revised 9`97 jm
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,,..PASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITT111(3
(Print or Type)
NORTH ANDOVER Mass. Date
(f �uilding Location ,gyp fL1vbeooe Permit #
--
AJ. 19?7GlO Ut°dle- A AOwners Name
ucsn'or)
New 7-1 Renovation Replacement fy—f Plans Submitted (�
(Print or Type)
Check one: Certificate
r/
Installing Company Name AC12Aut 1/a11Gh T
� U Corp.
Address I a 3eookhAu�eej
Partner.
VC/\n 640h 214 038y2
Firm/Co.
Business Telephone/1:1j614
03 6 L/2, qV 6 p19 y��d6 �
1219c(-
Name of Licensed Plumber or Gas Fitter /G1219B= L
(/all T
Insurance Coverage: Indicate the type of insurance coverage
by checking the
appropriate box:
Liability insurance. policy Other type of indemnity
U Bond 1
'.., Insurance Waiver: I, the undersigned, have been made
aware that the licensee of
t/hi-s application does not have any one of the a5ove three insurance coverages.
cz
Sig tune of owner/agent of property Owner
0 Agent
IJ
l hereby certify that all or the details and Infotmation I have submitted (or entered) In above application are true and accurate to the bcst of my
knowlcdge and that all plumbing work and Inrtxlladons petformcd under Permit itsecd for this application
will be In eomplianco with all pertinent
provisions of tho Massachusetts Slate Gas Code and chaplet 142 of tho General laws.
TYPE LICENSC:��
By-
Y
Title
Plumber
Gasfitter
Signature of Licensed
Master
Plumber or Gasfitter
City/Town•
Journeyman
APPROVED (OFFICE USE ONLY)
License iqumber
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1ST FLOOR
.IND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
"8TH FLOOR
(Print or Type)
Check one: Certificate
r/
Installing Company Name AC12Aut 1/a11Gh T
� U Corp.
Address I a 3eookhAu�eej
Partner.
VC/\n 640h 214 038y2
Firm/Co.
Business Telephone/1:1j614
03 6 L/2, qV 6 p19 y��d6 �
1219c(-
Name of Licensed Plumber or Gas Fitter /G1219B= L
(/all T
Insurance Coverage: Indicate the type of insurance coverage
by checking the
appropriate box:
Liability insurance. policy Other type of indemnity
U Bond 1
'.., Insurance Waiver: I, the undersigned, have been made
aware that the licensee of
t/hi-s application does not have any one of the a5ove three insurance coverages.
cz
Sig tune of owner/agent of property Owner
0 Agent
IJ
l hereby certify that all or the details and Infotmation I have submitted (or entered) In above application are true and accurate to the bcst of my
knowlcdge and that all plumbing work and Inrtxlladons petformcd under Permit itsecd for this application
will be In eomplianco with all pertinent
provisions of tho Massachusetts Slate Gas Code and chaplet 142 of tho General laws.
TYPE LICENSC:��
By-
Y
Title
Plumber
Gasfitter
Signature of Licensed
Master
Plumber or Gasfitter
City/Town•
Journeyman
APPROVED (OFFICE USE ONLY)
License iqumber
r Date. <<I.P ..% . �.
NORTH tTOWN OF NORTH ANDOVER
OE t`E '11, -tai
PERMIT FOR GAS INSTALLATION
9SS^CMuSEt JW
... � � /fi
This certifies that . ........ �...... !.. ... t.. .......... .
has permission for gas ihstallation-V.
3
in the building s of....�` :
Nori:h Andover, Mass.
Fee. .%r Lic. No. 1 _:f..✓ 'r.. r;�r}.!`.,
t
GAS INS ?ECTOR
WHITE: Applicarit ''-•"CANARY: Building Dept. PINK: Treasurer GOLD: File
Location oZ 0 A M p,90 ,C �GQ
No. `�-0 Date 3-Q �d 3
�aRTa
,ti0
TOWN OF NORTH! ANDOVER
O.tt.o
9
'
Certificate of Occupancy
$
f
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sAcmust.
Building/Frame Permit Fee
$
Y
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check # -5U / c;z,.
16244 /o M ((--
Building Inspector
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TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE,, OR DEMjyOLISH A ONE OR TWO FAMILY DWELLING
v
A. N %g.` `•7,&5�`"w.":
BUILDING PERMIT NUMBER:
c3� DATE ISSUED: C
/a ((A�_
SIGNATURE:
Building Commissioner/IngWor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
004001
N�
�j
Map Number Parcel Number
c
V
1.3 Zoning Information:
1.4 Dimensions:
n
}Property
IZ,z)vz� ' ZS
Zoning Distrid Proposed Use
Lot Areas Fronta e ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
R 'red Provided
lb
IL
1.7 Water Supply M.G.L.C.40.t54)
1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public Private ❑
Zone Outside Flood Zone
Municipal On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
2-0
N e (Print)
Address for Service
St re
Telephone
2.2 Owner of Record:
L
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Suupperrvvissor`:
Not Applicable ❑
�—
Licensed Construction Su isor:
J
License Number
Ad
Ltb -S335'-
Expiration Date
Signature
Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
i
dress
Expiration Date
Si nature
Telephone
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SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check au appUcable
New Construction ❑
Existing Building ❑
Repair(s)
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work: f�
Q.� a�QJ� z ".dzL
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
(1T'F'ICIAL
USEENLY w
1. Building
j t U v
(a) Building Permit Fee
Multiplier
2 Electrical
�^
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
�-
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
-T
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, k ,.. K -42w ,cas Owner/Authorized Agent of subject property
er by authorize to act on
half t rs reiv) to work authorizea byVis building permit application. . I Z�
Ae
t nature of Owner Date
SECTION 7b OWNER/A RIZED AGENT DECLARATION
I, ��� /�P as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
int N r
ZL�---35
Si iatafeof wner ent Date
NO. OF STORIES Z
BASEMENT OR SLAB s -�
SIZE OF FLOOR TI1VIBERS l s 2 3
SPAN
DINIENSIONS OF SILLS ol_
DINIENSIONS OF POSTS (z l
DIMENSIONS OF GIRDERS L U
HEIGHT OF FOUNDATION t THICKNESS `
SIZE OF FOOTING X
MATERIAL OF CFMVINEY
IS BUILDING ON SOLID OR FILLED LAND SP 1_.j L0
IS BUILDING CONNECTED TO NATURAL GAS LINE NZ)
Name
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
Location:_
City tJ-2— Phone # iii —5- 3 3
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
Company name `mac-, , �-•� w -a ��,;�� ___� ,�� L "iz.�d
Address
CiPhone#: L9 4 -S- 33 S
C.d V
Company name:
Address
City: Phone #:
Insurance Co. Policv #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00
and/or one years' imprisonment_as_vel_as_cMi,penattiesinshe%xn-fa STOP WORK ORDER.and_a.fine._of_($1t1DM)-aAay.againstme. l
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby u�thq4xwm.,wd penaltmeW perjury that the information provided above is true and correct.
Print name l4 -e.1.
Official use only do not write in this area to be completed by city or town official'
City or Town Penrrit/Licensing.
D
Building Dept
❑Check if immediate response is required 0
Licensing Board
p
Selectman's Office
Contact person: Phone #: ❑
Health Department
r-,
Other
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A..
The debris will be disposed of in:
L
(Location of Facility )
Signature &f P it Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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